CRS paper explores ACA discretionary spending

Posted on October 17, 2012 |
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The Affordable Care Act (ACA) reauthorized funding for numerous existing discretionary programs and created multiple new discretionary grant programs and provided for each an authorization of appropriations. Funding for all these discretionary programs is subject to action by congressional appropriators. A new report published by the Congressional Research Service (CRS) summarizes all the discretionary spending provisions in ACA.

The ACA permanently reauthorized the federal health centers program and the National Health Service Corps (NHSC), which provides scholarships and student loan repayments to individuals who agree to a period of service as a primary care provider in a federally designated Health Professional Shortage Area. The ACA also reauthorized and expanded existing health workforce education and training programs under Titles VII and VIII of the Public Health Service Act (PHSA). In addition, the Act created several new programs to increase training experiences in primary care, in rural areas, and in community-based settings, and provided training opportunities to increase the supply of pediatric subspecialists and geriatricians. It also expanded nursing workforce development programs.

The ACA authorized several new grant programs with a focus on preventable or modifiable risk factors for disease (e.g., sedentary lifestyle, tobacco use) and leveraged mechanisms to improve the quality of health care, develop and disseminate innovative strategies for improving the quality of health care delivery, and support for care coordination programs.

The Congressional Budget Office (CBO) estimated that ACA’s discretionary spending provisions, if fully funded, would result in appropriations of approximately $100 billion by 2021.

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Several days ago, the Congressional Research Service (CRS) published a report describing how the appropriations impasse and government shutdown will impact the Affordable Care Act (ACA). The report provides background information on the ACA, particularly focusing upon how the law impacts federal spending. This information is followed by an explanation of the various legislative attempts to defund or amend the ACA, as well as legal and procedural considerations in using the appropriations process to attack the law. CRS concludes by examining how the government shutdown would impact ACA implementation. The report found that implementing the ACA would be largely unaffected by the government shutdown, because most of the federal agencies implementing the ACA will be able to rely upon funds outside of discretionary spending and several actions associated with implementing the ACA would be considered exceptions to the Antideficiency Act, the law that bars the federal government from performing certain tasks during a shutdown.

A report released by the National Institute for Health Care Reform (NIHCR) finds that provisions under the Affordable Care Act (ACA) to increase the number of primary care physicians may not be sufficient to meet the rising demands of medical services. Such provisions under the ACA include higher payment rates and educational loan forgiveness for primary care doctors. NIHCR urges policymakers to focus on ways to expand primary care that will yield more timely results. Such improvements could include opening the field of primary care to more non-physician providers, and improving the efficiency of existing practitioners.

Today the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced $229.4 million invested in the National Health Service Corps. The investment will finance nearly 4,600 loan repayment and scholarship awards to clinicians and students, and grants to 32 states to support state loan repayment programs. The mission of the National Health Service Corps is to provide financial, professional, and educational support to medical, dental, and mental and behavioral health providers who will serve patient populations with limited access to quality health care. Since its establishment in 1970, the National Health Service Corps, has provided care to communities by supporting over 42,000 primary care providers.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced today the 500 practices in seven regions that will participate in its Comprehensive Primary Care Initiative. According to the CMS website, "the Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients." The 500 primary care practices participating in the CPC initiative will represent 2,144 providers serving an estimated 313,000 Medicare beneficiaries.

The Centers for Medicare and Medicaid Services (CMS) announced today that 500 Federally Qualified Health Centers (FQHCs) have been selected to participate in the Advanced Primary Care Practice demonstration project. These 500 centers will receive $42 million over three years to improve quality and coordination of health care delivery. The project is designed to evaluate the patient-centered medical home model. The goal of the model is to improve patient health and the quality of health care delivery while lowering the cost of of care. HRSA and the Center for Medicare and Medicaid Innovation Center developed the demonstration, which will be conducted from November 1, 2011 through October 31, 2014.

Today, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced $290 million in new funding from the Affordable Care Act (ACA) for the National Health Service Corps (NHSC) Loan Repayment Program to help increase the number of primary care providers in medically underserved areas. These funds will allow $60,000 in loan debt forgiveness to medical, dental, and mental health primary care providers who commit to practicing 2 years in an NHSC-designated service area. Additionally, the ACA allows for more leeway in administering NHSC funds, such as the opportunity to work full-time or half-time, as well as total loan forgiveness for a commitment of six years.

Low physician participation rates in Medicaid -- virtually since the program’s 1965 enactment[1] -- have long posed a key limitation to its effectiveness. Many factors are thought to account for limited physician participation but, historically, low payment rates have stood out as a primary underlying problem.[2] As of 2008, Medicaid physician fees stood at approximately 72 percent of Medicare fees[3]...

Strengthening and modernizing the health care workforce was a major goal of the Patient Protection and Affordable Care Act (ACA). The ACA contains dozens of provisions related to health care workforce issues, including strengthening primary care, national workforce policy development, increasing the supply of health care workers, and more. This Implementation Brief focuses on those provisions of the ACA that specifically target the strengthening of the primary care physician workforce.